吸烟指数与肺癌患者凝血指标的相关性

Relationship between smoking indexes and coagulation function in patients with lung cancer

目的观察不同吸烟指数肺癌患者凝血指标的变化，探讨吸烟对肺癌患者凝血功能的影响。方法选取2010年7月至2015年7月间北京市朝阳区中医医院收治的130例肺癌患者。回顾性收集患者的临床资料，按照吸烟指数（每天吸烟支数×吸烟年数）分为4组，其中不吸烟者为0组（32例），吸烟指数〈200支年为1组（30例），吸烟指数200—400支年为2组（33例），吸烟指数〉400支年为3组（35例）。观察各组患者间凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、D-二聚体（D—D）、血小板计数（PLT）、血小板比容（PCT）、平均血小板体积（MPV）和血小板分布宽度（PDW）的水平，比较各组问的差异。结果随着吸烟指数的增加，PT和APTT均逐渐降低，FIB、D-D、PLT和PCT水平均逐渐升高，组间差异均有统计学意义（均P〈0．05）。而MPV和PDW随吸烟指数的增加，组间均无明显变化，差异无统计学意义（P〉0．05）。结论吸烟可导致肺癌患者PT和APTT明显降低，与吸烟指数呈明显负相关。吸烟可导致FIB、D．D和PLT明显升高，与吸烟指数呈明显正相关。随着吸烟指数的增加，肺癌患者的血液高凝状态逐渐加重。

Objective To observe the changes of coagulation indexes in patients with lung cancer between different smoking indexes,and investigate the influence of smoking on blood coagulation function in these patients. Methods From July 2010 to July 2015,clinical data of 130 lung cancer patients treated in Chaoyang Traditional Chinese Medicine Hospital were retrospectively collected and reviewed. According to the smoking indexes（ daily smoking amounts × smoking years）,lung cancer patients were classified into 4groups. Group 0 was no smoking group（ n = 32）; smoking index less than 200 cigarettes was group 1（ n =30）; smoking index between 200 to 400 cigarettes was Group 2; and smoking index more than 400 cigarettes was Group3. Prothrombin time（ PT）,activated partial thromboplastin time（ APTT）,fibrinogen（ FIB）,D-dimer（ D-D）,platelet count（ PLT）,platelet hematocrit（ PCT）,mean platelet volume（ MPV）and platelet distribution width（ PDW） were compared between the 4 groups. Results With the increase of smoking index,levels of PT and APTT reduced gradually while levels of FIB,D-D,PLT and PCT increased gradually,with statistically significant differences between groups（ each P〈 0. 05）; However,there was no significant difference in the levels of PCT and MPV between groups（ P 〉 0. 05）. Conclusions Smoking can lead to a significant decrease of APTT and PT in patients with lung cancer,which was negatively associated with smoking index. Smoking can lead to a significant increase of FIB,D-D and PLT,which was positively associated with smoking index. With the increase of smoking index,hypercoagulability deteriorated in patients with lung cancer.